Documents for Health Claim

Following are the lists of documents that you will require to report a health claims:

Fixed benefit hospitalisation claim for ICICI Pru Hospital Care or ICICI Pru Hospital Care II

You will receive a sum as Fixed Benefit* for the number of days you were admitted in a hospital or type of surgery grade under the ICICI Pru Hospital Care and Hospital Care II policies. For reporting Fixed Benefit Hospitalisation claim, you will need the following documents:

  • Claimant's statement / Claim intimation form - Download Form Download Icon
  • Copy of Medical Records (Admission Notes, Discharge Summary and Test Reports)
  • Pre-authorization form (for cashless facility) - Download Form Download Icon
  • Attending Doctor's Certificate
  • Health check-up Form (for ICICI Pru Hospital Care II) - Download Form Download Icon
  • Cancelled Cheque

Indemnity Hospitalisation Claim applicable for ICICI Pru MediAssure or ICICI Pru Health Saver:

For the expenses made for hospitalisation and other related medical costs*, you will be compensated under the Indemnity Hospitalisation claim. For reporting this claim, you will need the following documents:

  • Claimant's statement / Claim intimation form - Download Form Download Icon
  • Original Discharge Card
  • Original Investigation Reports
  • Health check-up Form (for ICICI Pru Health Saver) - Download Form Download Icon
  • Original Hospital/ Pharmacy Bills & Payment Receipts and Records
  • Pre-authorization form (for cashless facility) - Download Form Download Icon
  • Health Saving Benefit Form (for ICICI Pru Health Saver) - Download Form Download Icon
  • Cancelled Cheque

Critical Illness Claim, Major Surgical Assistant Benefit Rider, Accidental Death Benefit Rider applicable for ICICI Pru Crisis Cover or ICICI Pru Heart / Cancer Protect or Rider Claim

To report a claim under ICICI Pru Crisis Cover or the above mentioned individual Riders**, you will need the following documents:

  • Claimant's statement / Claim intimation form - Download Form Download Icon
  • Attending Doctor's Certificate
  • Copy of Medical Records (Admission Notes, Discharge Summary and Test Reports)
  • Original Policy Certificate
  • Cancelled Cheque

*Please read your policy document for further details.
**A Rider is an extra benefit that can be purchased along with your policy for increasing your cover

Back to Top